Duke Lacrosse Accuser 's Psychiatric History - A 'Perfect Storm'?

   

        I was not surprised to hear the Revelation on CBS' 60 Minutes last night that the accuser in the Duke lacrosse case has a long psychiatric history (bi-polar) and has been on Seroquel and Depakote.

       From the beginning, in my posts and via private communications, I questioned whether this woman was on any psychotropic medications and whether or not she was having episodes of delusions.

     First of all, I'd like to clarify that I do not believe that just because someone has a history of psychiatric illness, any complaint they might make of sexual assault should just be tossed out the window.

     Just because someone has a mental illness doesn't mean they can't be raped. Sexual assault can happen to anyone of any race, age, occupation, or mental condition.

      However, I also believe that any complaint of sexual assault should be thoroughly investigated, prior to charging a suspect(s). That should include investigating the back ground of the accuser as well, especially if they have an illness which might cause them to have personality or conduct disorders, delusions, or hallucinations.

    While I agree that there is still too much stigma attached to mental illness, and complaints should not be ignored on that basis alone, we have to be realistic too.

     We need to realize that sometimes the accuser's reality may not be the same as everyone else's. I believe to ignore that possibility is to commit a grave injustice against anyone who might be charged with such a crime.

     A Victim Would Never Lie!

 I have read and heard this phrase so many times in the last 10 months. People have been shouting this from their soapboxes left and right - as if this one statement is enough to assure everyone within hearing distance that the three Duke lacrosse players are guilty.

    Why would a victim lie?, they ask. So these boys have to be guilty. Absolutely. No question about it, right?

   Wrong.

     On the surface, that statement is correct. No true victim would lie. However, not all accusers are true victims - and people need to realize that.

      Most women wouldn't lie. Unfortunately, there is a small segment of the population who, for whatever reason - vindictiveness, guilt, regret, fear of their parents finding out what they've been up to - attempt to manipulate the system outright by making false accusations.

     Then there are others who may suffer from various mental illnesses, such as schizophrenia, bi-polar disorder, histrionic personality or Munchhausen's Syndrome which may hinder rational behavior. 

       The detectives in our area take a dim view of false accusers.

     Of my own patients alone, I have had one arrested right there at the hospital, as she walked out of the SANE exam room.

     A second one, who they believed had staged the crime scene, was for possible arrest.

    And a third was going to be arrested as well, except that I asked if the police could get her to mental health services instead.

      My impression at the time was that she was totally out of touch with reality. She actually believed what she was saying. I didn't think it was right to arrest someone who was that delusional. 

     Persons like Victoria Peterson and Wendy Murphy should not stand there and try to tell everyone that no accuser would ever make a false claim. Experienced SANE / FNE's know better.

   Bi-Polar Disorder

        Bi-polar disorder is an illness involving extreme mood changes, beyond the normal ups and downs of life. It's characterized by cycles of deep depression and feelings of worthlessness.

      It's followed by periods of extreme manic behavior such as euphoria or extreme irritability, flights of fancy, grandiose ideas, lack of sleep, excessive buying sprees, increased aggressiveness, or a sex drive that's in overdrive.

      It often shows up in late teens or early twenty's. That person's history may also show ADHD throughout childhood and / or Opposition Deviance Disorder as they grow older.

      Quite often you will see a mixture of both manic and depressive symptoms. Some people may only have one, or few, episodes in their life; others may have frequent episodes, with moods quickly changing within a matter of hours, days, or weeks. This is known as rapid cycling.

      Persons who go untreated have trouble throughout their entire lives. They have trouble with school, work, and inter- personal relationships. They often drop out of school, get fired or quit jobs frequently; have failed marriages, abuse drugs / alcohol, end up in bankruptcy, and get into trouble with the law.

     Without treatment, the manic-depressive episodes can become more severe, ultimately leading to psychosis - a break with reality, and even suicide.

     The current treatment of choice is Lithium, a mood stabilizer, along with an anti-depressant. Anti-depressants alone are not recommended for bi-polar because they can cause the person to go into extreme manic episodes.

       Lithium has to be monitored very carefully. The risk of Lithium toxicity is high and it can be fatal. A Lithium level should be drawn every 3 months. Dehydration and salt removal from the body must be avoided since salt deficiency can result in lithium toxicity. Excessive alcohol intake must be avoided as well because it also can increase the loss of salt and water from the body.

      Other current treatments include a drug cocktail mix of Seroquel and Depakote. The Depakote is used in place of the Lithium. Normally used as an anti-convulsant, it has been found to be a good mood stabilizer, with reduced side effects. 

     The Seroquel is an anti-psychotic drug, used to keep the extreme manic episodes at bay. Depakote and Seroquel must also be monitored closely. Seroquel can cause memory loss and altered mental status.

     Caution must also be used when combining Seroquel with muscle relaxers, or drinking alcohol, as the sedative effects are increased.

       Histrionic Personality Disorder

       Histrionic Personality Disorder is a "chronic, often life-long pattern of maladaptive behavior, characterized by excessive emotional expression and attention-seeking behavior...  Individuals with HPD tend to be flirtatious, demanding of attention, seductive, but emotionally shallow."
   
     The person with this disorder is usually immature. He or she is dependent on others, is self-centered, and often vain. The person's behavior is intended to gain attention.
   
     "They are prone to impulsive and dramatic displays of emotion and are easily influenced by others. HPD individuals find it difficult to delay gratification, and are often crushed by what they perceive as rejection."

     "These individuals display overly dramatic and attention seeking behaviours. They are shallow of emotions, self-centered and they can be inappropriately sexually provocative. "

     This type of person must be the center of attention at all times - even going to extreme measures to get it. This type of behavior applies to women, while anti-social disorder applies to men.

       Characteristics includes immaturity, sexually provocative behavior, theatrical type behavior, exaggerated statements (and symptoms). Their behavior is easily suggestible by other people or circumstances.

     When they don't get their own way, or feel rejected by others, they may throw temper tantrums or plan revenge. They are often involved in drug / alcohol abuse.

     This type of disorder belongs to the DSM III -R group cluster of personality disorders, Cluster B:  disorders characterized by dramatic, emotional or erratic behaviors. 
                                                 antisocial 
                                                 borderline 
                                                 histrionic 
                                                 narcissistic


        It has been stated that the Duke lacrosse accuser has a history of bi-polar disorder. What is known of her long-term behavior would certainly indicate it. However, I am also including some information on histrionic personality disorder.
 
        Quite often, you will find persons suffering from a combination of different personality disorders. I can't help but question, given the accuser's exaggerated, rapidly changing, and hysterical type behavior, and statements, both during and after the party, whether she also suffers from histrionic personality disorder.

      In fact, when you look at her known history and occupation, as well as her behavior and statements after the party, they appear to show almost classic symptoms for this disorder.

     I began to get suspicious when I first read of Gottlieb reporting first that she screamed at the sight of a white man (sorry, but I had to laugh at that one), then that the speculum exam took an excessively long time due to "extreme pain". There usually isn't any "extreme pain" involved with inserting a speculum.

     Our patients don't go screaming at the sight of a white man - or any man for that matter. They are usually just the opposite - either very subdued or talking, relaxing, or sleeping in the family room.

      Often they arrive with male friends or family members. Until our exam room got relocated, we had to walk every patient through the ED to get to the bathroom.

     The ED is filled with men. Police, detectives, nurses, technicians, patients, security guards coming, going, and standing around all over the place. Not once has a single patient of mine ever shown any discomfort or fear at the sight of these men. Never.

     These two statements flew up the first red flags. Others included the accuser stating that she and Kim Roberts went screaming into the night. Then Kim reported that the accuser suddenly started screaming and yelling out at the boys while they were in the bathroom.

     My first thought at that was that the accuser was ticked off at someone big time. Not afraid. Ticked off!

      Why? I believe the answer lies in later statements that implied the players rejected her. Histrionic personality types can't handle any type of rejection.

       One day later, the accuser was at UNC, once again with extreme symptoms, trying to get some Percocet. Two days later, Sgt. Gottlieb supposedly observed the accuser, at her home, in anguish. The poor woman could barely walk or sit. Once again, I felt that those were exaggerated symptoms.

   There seems to be a pattern here.

      Persons with bi-polar disorder often have co-morbid personalty disorders. According to an article on Medscape Today, "The incidence of comorbid personality disorder ranges from 45 to 65%, with borderline personality as the most prevalent, followed by histrionic personality disorder."

    "Personality disorder traits predict poorer medication compliance among bipolar adults, and the social support that buffers against relapse is lacking.^[15] Bipolar patients with personality disorders also spend more days in the hospital in a given year,^[16] are less likely to achieve symptomatic recovery,^[17] have more severe mood disorder symptoms, and function at a lower level than those without personality disorders. "  Many are also involved in drug / alcohol abuse and drug-seeking behaviors.

     When you look at the accuser's behaviors and statements in this context, everything  seems to make sense: the erratic behavior, the stumbling around, yelling from the bathroom, banging on the door to get back in, then passing out on the steps; jumping at the suggestion of rape given by the nurse, changing her mind twice, followed by the refusal to speak to the police officer, the exaggerated complaints at the hospitals and in the interview with Gottlieb; pole dancing while at the same time claiming back injuries, changing her stories multiple, multiple times, not getting anything straight, poor relationships, impulsive behaviors, even her poor (sexually provocative) career choices ...

        According to pharmaceutical literature, the Seroquel / Depakote combination is used specifically to prevent extreme manic episodes. When viewing her behavior, it appears she may have been off her medicine.

       If extreme manic behavior is not treated, it often will progress to psychosis, including delusions. I cannot help but question if that is what happened in March, 2006.

     It seems to me, there are indicators that both of these disorders, as well as drug seeking behavior, and alcohol abuse, may have all combined together to create a 'Perfect Storm'. 

     A storm which has raised racial tensions across the country, hurt innocent people, ruined careers, and tarnished the name of a renown university.

      It's a storm that needs to end.   

   

    

   

 

    

 

 

 

 

 

    

 

Comments

[Bill]

I'll still be slammed for saying this even when I disbelieve her story, but I see the AV as a rather pitiable and maliciously exploited person. Nifong and the Duke 88 have opportunistically and cruelly used a mentally ill woman as much as they mercilessly and pitilessly used the Duke 3 and the Lax team as a whole.

[Esquire]

I put this on the wrong thread, so I'll repost it corectly:

Kathy: Makes you wonder on that whole rejection theme. Why did she keep saying there was "more money to be made?" Why did she go to the back door? What did the players in the house say when she was talking through the door?

A typical lacrosse player in a situation where someone like the woman involved here asks if they would like a little something in exchange for "more" money would go into instant insult mode. Things like "Huh? Get real, go away." You can imagine, perhaps, something more closely resembling what they would say. It would be cold.

Did this sort of rejection of services perhaps influence her later claims? That she was owed money, and did not get it? That their collective rejection of her suggestions made her seek revenge?

You make a very good argument, and when taken in context of a woman who had as much foreign DNA material in her body as this woman did, I think the answer may have been staring at all of us the entire time.

-Esquire-
-Maryland-

[Kathleen]

Bill:

I understand your point and agree to a certain extent. However, even though the accuser may have mental health issues, I do not see her as a victim. Just because someone has bipolar, doesn't mean they don't know right from wrong.

[Kathleen]

Esquire:

You've made a point I've often wondered about. I question whether there wasn't a rejection that night that the accuser took too personally.

What caused Kim to start making cutting "personal" remarks, after the boys had helped carry/ walk the accuser to the car?

(Did I get that sequence right? There's been so much, it's hard to keep track.)

I never understood what started that. In her 60 minutes interview, she seemed like she was conversing with the boys ok, then she starts making cutting remarks.

I can't help but wonder what all was said because I get the feeling like something's been left out.

When the accuser made that prior rape claim years ago - the one with details so eerily similar to this case, could that have been perceived rejection too? I wonder.

As for all that DNA - customers? Or extreme promiscuity? One of the classic signs of manic behavior.

[Tom D.]

Kathleen,

Your descriptions of bi-polar disorder and histrionic personality disorder appear to be accurate. But, you do not appear qualified to or have sufficient information to make any statements, however tentative or qualified, regarding the accuser's mental condition or whether that condition may have had any impact on her behavior the night of the alleged events.

Your biography shows no experience directly treating individuals specifically for psychiatric disabilities and you do not appear to have any formal training in psychology, psychiatry or psychopharmacology.

Psychiatric disabilities are notoriously difficult to diagnose, including most especially bi-bolar disorder. I worked with five experienced psychiatrists before I was accurately diagnosed and treated for BP-II. None of the doctors made mistakes. The disease is just very difficult to diagnose. Of course, my case, like the accuser's, is unique.

In addition to the problems of diagnosis, patient responses to psychotropic medication are unpredictable and vary widely from one patient to another. The variety of positive responses, side effects and discontinuation symptoms to the same medication are numerous.

In this instance, we do not know the full panoply of mental disorders she may suffer from. We do not know the precise dosage or the length of time she was on depakote or seroquel (or any other medication) and we have no precise information regarding whether or when she discontinued any of her medications.

While your intentions are obviously good and I applaud your sympathy towards people who suffer from psychiatric disorders, given the continuing stigma associated with these disorders, it would be best not to suggest soemthing might be a "perfect storm" when it is frankly quite impossible for you or anyone else (other than perhaps medical personnel who have treated her) to have sufficient enough nformation to do so.

[NYEsq83]

Great work, well-crafted.

[Kathleen]

Tom D.

Thank you for your response and I respect your opinion. I probably should have included my professional experience.

First off, I am not a psychiatric nurse. When choosing among the various areas in which to work, I was always more interested in trauma and critical care.

Those are the areas I concentrated on before moving into home health care.

Prior to our psychiatric nursing training, we were required to take psychology courses at our local college.

Psychiatric training was a requirement in nursing school +30 years ago.

My initial psychiatric nursing training was taken at the old Phipps Clinic, Johns Hopkins Hospital in Baltimore.

That was followed by more training at Crownsville state Hospital and Sheppard Pratt Hospital.

While I didn't go into the Psychiatric nursing field, nevertheless, I still received a certain amount of psych experience. All nurses do, no matter where they work.

That's because we deal with the general public and our patients would come in with a variety of mental health issues.

Also, we are all given inservices, at various times throughout our careers, to help keep us abreast of new developments and learn about new medicines.

At one point in my career, I decided to go on my hospital float pool in order to have more time flexibility.

During that period, I often floated to our Psychiatric unit.

Ten years of home health care, visiting patients in their own homes, also gave me experience, as we had many patients who had psycho-social, as well as physical health issues. It was an excellent learning experience.

Prior to deciding to go independent, I worked as a nurse consultant, auditing state residential facilities.

My job was to ensure that the facilities were in compliance with state regulations, see that the standard of care was being followed, investigate and testify regarding suspicious injuries, and educate staff on health care, medication administration, and correct documentation.

Most of the residents had psycho-social issues, a psychiatric diagnosis, and were on a variety of psychotropic medication combinations.

As it was my job to monitor their care, as well as the safety of the staff, I was required to be knowledgable about a variety of illnesses such as schizophrenia, bipolar, conduct & other personality disorders, as well as the meds each person was on.

We had a few residents who could, and did, become aggressive or violent.

One held a staff member against a wall, with a pair of scissors to his neck, and I had to not only talk him out of it, but get him to agree to go with the police to the hospital - all done by phone, since I was sitting an hour away.

Trust me, I was in almost daily contact with their treating psychiatrists!

That was another excellent learning experience. One I don't think I'll ever forget! :-)

[Tank]

Kathleen -

As always, thank you for your excelent work. A few small comments.

1) The new information we were given in the 60 minutes piece is that CGM has a history of taking Seroquel and Depakote. From that many of us (lay people) have assumed that she suffers from bipolar disorder. Is there another disorder that would call for those two drugs?

2) Somewhat off the immmediate topic, you've previously indicated that the SANE nurse had only been an RN for 7 months, and had just completed here SANE training. Do we know how many SANE exams she had performed prior to this one? I keep getting this awful feeling that it was her first ever.

3) We know CGM had her baby by C section on Wed, Jan 3rd. If she was full term that means she got pregnant April 12 - the day after the interview with Gottleib where she could "barely walk or sit down" because her injuries were so severe.

Is it likely that she has been off her medications since finding out she was pregnant? Could an extended depressive phase explain why she was so willing to go along with Nifong et al?

[LKG]

Kathleen,

Excellent piece. Thanks for the information...

[Durhamite]

Nifong used this entire charade for votes, and to divert attention to the rise in crime! People are murdered every other day, and I never would have imagined my city would become so vile!

The corruption and abuse of power occurs at the highest levels, and I am praying the people will take charge, make change, and not let our home become a Southern version of Serpico.....